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Discursive patterns in multiprofessional healthcare teams
Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Äldre - vård - civilsamhälle (ÄVC). Linköpings universitet, Filosofiska fakulteten.ORCID-id: 0000-0002-1443-5895
2006 (engelsk)Inngår i: Journal of Advanced Nursing, ISSN 0309-2402, Vol. 53, nr 2, s. 244-252Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Aim. The aim of this paper is to report a study exploring how members of multiprofessional healthcare teams talk about their team. Specifically, the team members' talk was analysed to explore the discursive patterns that emerged and their functions.

Background. Over recent decades there has been an increasing demand in Western countries to change care organizations and to coordinate resources and professional competencies to meet the needs of patients/service users better. Because society promotes this kind of work, it may be valuable to explore the self-presentations of a multiprofessional healthcare team.

Methods. A discourse analysis was carried out on existing empirical data from focus group interviews with a member-identified category sample comprising 32 healthcare professionals in six authentic multiprofessional teams in south-east Sweden. The analysis focused on the participants' discursive constructions of multiprofessional teamwork, on the way they talked about their group, and, in particular, on their use of the pronouns we, they and I.

Findings. The constructions of 'we' by multiprofessional healthcare teams showed discursive patterns that are here referred to as knowledge synergy and trusting support, which included factors such as cross-learning and personal chemistry. The pronoun we was also used as a flexible resource to manage expertise, power and leadership within the teams, and it might also function to ease the pressure for consensus.

Conclusion. These discursive patterns provided powerful rhetorical resources for team members, both to affirm their choice of membership and to claim superiority in relations with the surrounding community (the others) by linking to a societal discourse that promotes collaboration.

sted, utgiver, år, opplag, sider
2006. Vol. 53, nr 2, s. 244-252
Emneord [en]
discourse analysis, inter-professional practice, membership, nursing, self-presentations, teamwork
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-14668DOI: 10.1111/j.1365-2648.2006.03719.xOAI: oai:DiVA.org:liu-14668DiVA, id: diva2:24187
Tilgjengelig fra: 2007-10-12 Laget: 2007-10-12 Sist oppdatert: 2015-01-19
Inngår i avhandling
1. Interprofessionella team i vården: En studie om samarbete mellan hälsoprofessioner
Åpne denne publikasjonen i ny fane eller vindu >>Interprofessionella team i vården: En studie om samarbete mellan hälsoprofessioner
2007 (svensk)Licentiatavhandling, med artikler (Annet vitenskapelig)
Abstract [en]

There are great expectations that collaboration among professions and various sectors will further develop health care and thus lead to improved public health. In the World Health Organization’s declaration “Health 21” the designated goal for health professions in the member nations in Europe by the year 2010 is to have developed health promotional competence, including teamwork and cooperation based on mutual respect for the expertise of various professions. The challenges faced by the interprofessional teams are, however, multifaceted, and these challenges place demands upon society, which, in turn, determines the fundamental conditions for collaboration among the health professions within the health care organizations.

This licentiate dissertation contains discourse and content analyses of interprofessional teamwork in health care. The major objective of this dissertation is to study and describe how the team members construct and create the content and significance of teams and teamwork among health professions. One specific goal has been to study how the members of a multi-professional health care team refer to their team, especially the discursive patterns that emerge and the function that these patterns has (I). The second specific goal has been to identify and describe the difficulties that the health professionals have experienced within their interprofessional teamwork. One purpose has been to enable discussions of the implications for interprofessional learning (II).

Focused group interviews with team members (n=32) from six teams were studied using discursive social psychological research approach. The analysis concentrated on the use of the pronouns “I”, “we” and “them”. The results were then analyzed in relation to theories on discursive membership and discursive communities (I). Individual semi-structured interviews with team members (n=18) from four of the six teams were carried out using critical incident techniques. The interviews were analysed via latent qualitative content analysis and the results were interpreted in the light of theories on sociology of professions and learning at work (II).

The findings showed that two discursive patterns emerged in the team members’ constructions of “we the team”. These patterns were designated knowledge synergy and trustful support (I). The following three themes that touched upon the difficulties of interprofessional teamwork were identified in the personal interviews: (A) difficulties concerning the teams’ dynamics that arose when the team members acted as representatives for their respective professions; (B) difficulties when the various contributions of knowledge interacted in the team; and (C) difficulties that were related to the surrounding organisation’s influence on the team (II).

The conclusion was reached that the discursive pattern provided rhetorical resources for the team members, both in order to reaffirm membership in the team and to promote their views with other care providers, but also to deal with difficulties regarding, for example, lack of unity in outlook. The conclusion was also drawn that, in addition to the individual consequences, one outcome of the perceived difficulties was that they caused limitations of the use of collaborative resources to arrive at a holistic view of the patient’s problems. Thus the patients could not be met in the desired manner.

The practical implications of the research project concern the development of teams in which various forms of interprofessional learning can influence the continued development of the team and the management of health care in regard to the importance of implementation processes and organisational learning.

Abstract [sv]

Stora förväntningar ställs på att samarbete mellan yrkesgrupper och mellan sektorer ska utveckla hälso- och sjukvården och leda till en förbättrad folkhälsa. I Världshälsoorganisationens policydokument “Health21” anges exempelvis målsättningen att hälsoprofessionerna i de europeiska medlemsländerna till år 2010 ska ha utvecklat en hälsofrämjande kompetens som bland annat innefattar teamarbete och samarbete på basis av ömsesidig respekt för de olika professionernas expertis. Det interprofessionella teamets utmaningar är dock mångfacetterade och kräver uppmärksamhet från det samhälle som skapar villkoren för hälsoprofessionernas samarbete inom hälso- och sjukvårdens organisationer.

Denna licentiatavhandling innehåller diskurs- och innehållsanalytiska studier om interprofessionellt teamarbete i vården. Avhandlingens övergripandet syfte var att undersöka och beskriva hur teammedlemmar konstruerar och skapar innebörder av team och teamarbete mellan flera hälsoprofessioner. Det ena specifika syftet var att undersöka hur medlemmar i multiprofessionella vårdteam talar om sitt team, särskilt avseende de diskursiva mönster som framträdde och vilken funktion dessa mönster hade (studie I). Det andra specifika syftet var att identifiera och beskriva svårigheter som hälsoprofessioner har uppfattat vid interprofessionellt teamarbete, där avsikten även var att möjliggöra en diskussion om implikationer för interprofessionellt lärande (studie II).

Fokusgruppintervjuer med teammedlemmar (n=32) från sex team analyserades utifrån en diskursiv socialpsykologisk forskningsansats och fokuserade på användningen av pronomina ”jag”, ”vi” och ”de”. Fynden relaterades sedan till teorier om diskursivt medlemskap och diskursiva samhällen (studie I). Individuella semistrukturerade intervjuer med teammedlemmar (n=18) från fyra av de sex teamen genomfördes med critical incident-teknik. Intervjuerna analyserades via latent kvalitativ innehållsanalys och fynden tolkades utifrån teorier om professionssociologi och lärande i arbetet (studie II).

Resultaten visade att två diskursiva mönster framträdde i teammedlemmarnas konstruktioner av ”vi-som-team”. Dessa mönster benämndes kunskapssynergi och tillitsfullt stöd (studie I). Vid individuella intervjuer med teammedlemmar identifierades följande tre teman som rörde svårigheter vid interprofessionellt teamarbete; (i) svårigheter som gällde den teamdynamik som uppstod när teammedlemmarna agerade som företrädare för sina professioner i relation till teamet, (ii) svårigheter när medlemmarnas olika kunskapsbidrag interagerade i teamet och (iii) svårigheter som rörde den omgivande organisationens påverkan på teamet (studie II).

Konklusionen gjordes att de diskursiva mönstren utgjorde retoriska resurser för teammedlemmarna, både för att bekräfta medlemskapet i teamet, för att hävda sina åsikter i kontakter med andra vårdgivare (”de andra”) och även för att hantera uppfattade svårigheter beträffande exempelvis bristande samsyn. Vidare drogs slutsatsen att en konsekvens av de uppfattade svårigheterna var, förutom individuella konsekvenser, begränsningar i användandet av de gemensamma resurserna för att nå en helhetssyn på patientens problem och att patienterna inte kunde bemötas på det sätt som önskades.

Forskningsprojektets praktiska implikationer rörde teamutveckling där olika former av interprofessionellt lärande påverkar teamets fortsatta utveckling, samt ledning av hälso- och sjukvården avseende betydelsen av imple-menteringsprocesser och organisatoriskt lärande.

sted, utgiver, år, opplag, sider
Institutionen för medicin och hälsa, 2007. s. 61
Serie
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 83
Emneord
health professions, interprofessional, interprofessional learning, teamwork, Keywords: collaboration, critical incident technique, discourse analysis, critical incident-teknik, diskursanalys, hälsoprofessioner, interprofessionell, interprofessionellt lärande, samarbete, teamarbete
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-9837 (URN)978-91-85831-05-0 (ISBN)
Presentation
2007-10-17, Almen, ingång 65, Universitetssjukhuset i Linköping, Linköping, 13:00 (engelsk)
Opponent
Veileder
Tilgjengelig fra: 2007-10-12 Laget: 2007-10-12 Sist oppdatert: 2015-01-19

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